Application of flexible sheath for holmium laser fiber in the treatment of impacted upper ureteral stones by rigid ureteroscope
-
摘要: 目的 研究钬激光光纤用可转弯鞘套在输尿管硬镜对复杂输尿管上段结石治疗中的应用价值，验证其有效性、安全性及经济性，并探讨其在基础医疗单位应用的前景。方法 选取重庆医科大学附属永川医院2018年12月—2021年6月符合标准的复杂输尿管上段结石患者158例，对照组75例采用输尿管硬镜钬激光碎石，试验组83例采用输尿管硬镜钬激光碎石的同时必要时结合钬激光光纤用可转弯鞘套。观察2组手术时间、术后住院时间、住院费用，首次结石清除率、二次手术率、术后并发症发生率以及1个月后结石清除率等指标。结果 试验组术后住院时间、二期行体外冲击波碎石比例、二期行输尿管软镜比例、住院总费用均显著少于对照组，而首次结石清除率高于对照组(P＜0.05)；手术时间、术后并发症发生率、1个月后结石清除率比较，2组间差异无统计学意义(P＞0.05)。结论 钬激光光纤用可转弯鞘套在输尿管硬镜钬激光碎石术中可以作为部分复杂输尿管上段结石的结合选择方式，提高其首次结石清除率，降低住院费用，在基层医院中有一定应用价值。
-
关键词:
- 复杂输尿管上段结石 /
- 激光光纤用可转弯鞘套 /
- 输尿管硬镜 /
- 钬激光
Abstract: Objective To investigate the application value of flexible sheath for holmium laser fiber in the treatment of impacted upper ureteral stones by rigid ureteroscope, and to verify its effectiveness, safety and economy, and explore the prospects of its application in hospitals at primary levels.Methods From December 2018 to June 2021, 158 patients with impacted upper ureteral stones were selected from Yongchuan Hospital of Chongqing Medical University. Seventy-five patients in the control group were treated with rigid ureteroscopic holmium laser lithotripsy, while 83 patients in the experimental group were treated with rigid ureteroscopic holmium laser lithotripsy combined with flexible sheath for holmium laser fiber if necessary. The operation time, postoperative hospital stay, hospitalization expenses, primary stone clearance rate, the second operation rate, the incidence of postoperative complications and the stone clearance rate after one month were observed.Results The postoperative hospital stay, proportion of extracorporeal shock wave lithotripsy in the second stage, proportion of flexible ureteroscope in the second stage and total hospitalization expenses in the experimental group were significantly less than those in the control group, and the stone clearance rate in the first stage was significantly higher than that in the control group (P< 0.05). There was no significant difference in operation time, postoperative complications or stone clearance rate after 1 month between the two groups (P> 0.05).Conclusion Flexible sheath for laser fiber can be used as a combination of choice for some impacted upper ureteral stones in ureteroscopic holmium laser lithotripsy, which can improve the stone clearance rate and reduce the hospitalization expenses. It has certain application value in hospitals at primary levels. -
-
表 1 2组患者一般资料比较
例，X±S 指标 例数 年龄/岁 性别 结石位置 结石长径/cm 肾窦分离/cm 男 女 左 右 对照组 75 50.3±13.6 40 35 43 32 1.5±0.37 3.4±1.2 试验组 83 49.6±15.9 44 39 48 35 1.4±0.41 3.1±1.6 P值 0.81 0.968 0.95 0.67 0.28 
下载: 导出CSV
表 2 2组患者术后治疗效果及并发症比较
组别 对照组 试验组 P值 手术时间/min 50.1±23.4 52.3±25.2 0.270 术后住院时间/d 5.2±1.2 2.6±1.3 0.035 首次术后结石清除率/% 68.0(51/75) 85.5(71/83) 0.009 行体外冲击波碎石/% 24.0(18/75) 12.0(10/83) 0.049 行输尿管软镜/% 25.3(19/75) 8.4(7/83) 0.004 住院总费用/元 15 749±4527 10 613±2140 0.020 并发症发生率/% 6.7(5/75) 7.2(6/83) 0.890 1个月后结石清除率/% 97.3(73/75) 96.4(80/83) 0.745
下载: 导出CSV
-
[1] Roberts WW, Cadeddu JA, Micali S, et al. Ureteral stricture formation after removal of impacted calculi[J]. J Urol, 1998, 159(3): 723-726. doi: 10.1016/S0022-5347(01)63711-X
[2] Tran TY, Bamberger JN, Blum KA, et al. Predicting the Impacted Ureteral Stone with Computed Tomography[J]. Urology, 2019, 130: 43-47. doi: 10.1016/j.urology.2019.04.020
[3] Torricelli FCM. Impacted large ureteral stone: What is the best approach?[J]. Int Braz J Urol, 2021, 47(1): 71-72. doi: 10.1590/s1677-5538.ibju.2019.0638.1
[4] Kadyan B, Sabale V, Mane D, et al. Large proximal ureteral stones: Ideal treatment modality?[J]. Urol Ann, 2016, 8(2): 189-192. doi: 10.4103/0974-7796.157963
[5] White W, Klein F. Five-year clinical experience with the Dornier Delta lithotriptor[J]. Urology, 2006, 68(1): 28-32. doi: 10.1016/j.urology.2006.01.031
[6] Wang Y, Zhong B, Yang X, et al. Comparison of the efficacy and safety of URSL, RPLU, and MPCNL for treatment of large upper impacted ureteral stones: a randomized controlled trial[J]. BMC Urol, 2017, 17(1): 50. doi: 10.1186/s12894-017-0236-0
[7] Pasqui F, Dubosq F, Tchala K, et al. Impact on active scope deflection and irrigation flow of all endoscopic working tools during flexible ureteroscopy[J]. Eur Urol, 2004, 45(1): 58-64. doi: 10.1016/j.eururo.2003.08.013
[8] Marchini GS, Torricelli FC, Batagello CA, et al. A comprehensive literature-based equation to compare cost-effectiveness of a flexible ureteroscopy program with single-use versus reusable devices[J]. Int Braz J Urol, 2019, 45(4): 658-670. doi: 10.1590/s1677-5538.ibju.2018.0880
[9] Sorokin I, Mamoulakis C, Miyazawa K, et al. Epidemiology of stone disease across the world[J]. World J Urol, 2017, 35(9): 1301-1320. doi: 10.1007/s00345-017-2008-6
[10] Pradère B, Doizi S, Proietti S, et al. Evaluation of Guidelines for Surgical Management of Urolithiasis[J]. J Urol, 2018, 199(5): 1267-1271. doi: 10.1016/j.juro.2017.11.111
[11] Xu G, Wen J, Li Z, et al. A comparative study to analyze the efficacy and safety of flexible ureteroscopy combined with holmium laser lithotripsy for residual calculi after percutaneous nephrolithotripsy[J]. Int J Clin Exp Med, 2015, 8(3): 4501-4507.
[12] Ziaee SA, Halimiasl P, Aminsharifi A, et al. Management of 10-15-mm proximal ureteral stones: ureteroscopy or extracorporeal shockwave lithotripsy?[J]. Urology, 2008, 71(1): 28-31. doi: 10.1016/j.urology.2007.08.025
[13] Bozkurt IH, Yonguc T, Arslan B, et al. Minimally invasive surgical treatment for large impacted upper ureteral stones: Ureteroscopic lithotripsy or percutaneous nephrolithotomy?[J]. Can Urol Assoc J, 2015, 9(3-4): E122-E125.
[14] Choi JD, Seo SI, Kwon J, et al. Laparoscopic Ureterolithotomy vs Ureteroscopic Lithotripsy for Large Ureteral Stones[J]. JSLS, 2019, 23(2): e2019.00008. doi: 10.4293/JSLS.2019.00008
[15] 鲁向阳, 李文亮, 李春明. 术前留置双J管时间对经输尿管软镜治疗肾结石的疗效影响[J]. 临床泌尿外科杂志, 2020, 35(2): 108-111. http://lcmw.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=3089c684-7b57-4973-9700-0b757693754b
[16] Aboutaleb H, Omar M, Salem S, et al. Management of upper ureteral stones exceeding 15 mm in diameter: Shock wave lithotripsy versus semirigid ureteroscopy with holmium: yttrium-aluminum-garnet laser lithotripsy[J]. SAGE Open Med, 2016, 4: 2050312116685180.
[17] Gökce M, Akpinar Ç, Obaid K, et al. Comparison of retrograde ureterorenoscopy(URS)and percutaneous anterograde ureteroscopy for removal of impacted upper ureteral stones > 10 mm in the elderly population[J]. Int Braz J Urol, 2021, 47(1): 64-70. doi: 10.1590/s1677-5538.ibju.2019.0638
[18] 段志国, 袁敬东, 章传华, 等. 经尿道负压鞘碎石取石治疗输尿管嵌顿性结石的疗效评价[J]. 临床泌尿外科杂志, 2021, 36(6): 478-480, 484. http://lcmw.cbpt.cnki.net/WKC/WebPublication/paperDigest.aspx?paperID=f3fd17c2-53a0-4cca-9e93-3a0a7829daf3
-
图(3)
表(2)
计量
- 文章访问数: 1274
- PDF下载数: 191
- 施引文献: 0